Knulst Rowan, Bosman Willem-Maarten, Ritchie Ewan D, da Costa Andy
Department of Surgery, Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
BMJ Case Rep. 2014 Apr 25;2014:bcr2014203873. doi: 10.1136/bcr-2014-203873.
A 49-year-old woman with a painless mass in the neck was examined by the surgeon. Imaging and cytology prior to surgery suggested the mass to be either a thyroid cyst or a branchial cleft cyst. After surgery, the patient reported a hoarse voice and the pathologist confirmed the removed lesion to be a cystic schwannoma of the left recurrent laryngeal nerve. The inconclusive imaging results, combined with colloid-like material in the punctate should prompt the investigator to include cystic schwannoma in the differential diagnosis. With the probability of a neurogenic origin of the mass in mind, nerve-sparing surgery can be performed. As a future prospect, positron emission tomography scans are mentioned as a modality with possibilities to discriminate a cystic schwannoma from other common cystic lesions.
一名49岁颈部有无痛性肿块的女性接受了外科医生的检查。手术前的影像学和细胞学检查提示该肿块要么是甲状腺囊肿，要么是鳃裂囊肿。手术后，患者出现声音嘶哑，病理学家证实切除的病变是左喉返神经的囊性神经鞘瘤。不确定的影像学结果，加上穿刺物中类似胶体的物质，应促使研究者将囊性神经鞘瘤纳入鉴别诊断。考虑到肿块有神经源性起源的可能性，可以进行保留神经的手术。作为未来的展望，正电子发射断层扫描被提及作为一种有可能将囊性神经鞘瘤与其他常见囊性病变区分开来的检查方式。
